ADOPTION AND PRENATAL ALCOHOL AND DRUG EXPOSURE
Some Prevalent Beliefs About Prenatal Drug
and Alcohol Exposure and The Research
Early negative findings on cocaine-exposed newborns engendered widespread media and public perceptions of a causal link between poor mothers' substance use and serious problems in their offspring. Despite later research questioning the prevalence of the problems and implicating other environmental and economic factors, these mothers were stigmatized and criminalized . . .
Lyons and Rittner 1998
The drug epidemic will result in a host of "cocaine/crack babies" and other highly disabled newborns whose prenatally induced impairments will interfere with social and academic functioning and constitute as immense social burden.
The effects of drug exposure on infant behavior and subsequent development represent a subtle and complicated process which must take into account various aspects of the child's prenatal exposure, the child's own biological vulnerability, and various other environmental factors. [Barth 1991; Beckwith 1990; Tyler 1992; Quinton et al. 1992].
Prenatal exposure to psychoactive substances is always associated with negative outcomes.
The effects reported in infants who are exposed in utero to substances cross a wide range: from severe [neurological damage and growth retardation] to normal developmental outcomes. The factors affecting developmental outcomes include:
- genetic vulnerability
- drug type
- exposure history
- maternal health and medical history
- access to medical care
- caregiving factors
- family environment
- social environment [such as the family's socioeconomic level]
A number of studies have shown that the interaction pattern between mother and child as well as other social factors appear to have more effect on some outcomes for children than does prenatal exposure to specific drugs [Myers et al. 1992; Barth 1991]. There are, however, certain types of developmental effects that are associated with prenatal alcohol and drug exposure to certain substances as shown on the next pages.
Potential Effects of Certain Drugs on Children
[Adapted from Kropenske et al. 1994]
Neonatal withdrawal syndrome [associated with prenatal opiate exposure]
Behavioral alterations [such as orientation to inanimate stimuli and cuddliness; appears to be associated with the type of prenatal drug use, with greatest association being with maternal use of depressants such as methadone or alcohol or polydrug abuse]
Crying [associated with prenatal exposure to cocaine; can be high-pitched and piercing or, on the other hand, infant can appear to be "underaroused"]
|Infancy [one month to 2 and 1/2 years]
Research generally shows that the actions of various drugs on the infant's behavior tend to vary over time but that most infants fall within the "normal" range.
Research also suggests that some of the infant behavioral characteristics [irritability, state control, responsiveness to social stimulation, sleep patterns, and crying] effect mother/infant attachment and their patterns of interaction may be the most significant result of prenatal exposure. Because the evidence suggests that children of parents who misuse drugs/alcohol are more likely to experience abuse and neglect and behavioral disturbances, there has been significant concern when children remain with their birth parents.
Cognitive and motor development have been the primary foci of research but the results have not been completely consistent - some studies have found no effects of exposure on any aspects of behavior and others have found some effects. Some of the common findings:
infants in all groups [drug exposed and various contrast groups] are all in the "average range"
there do appear to be more differences in "motor" rather than "mental" scores particularly for those children exposed to cocaine and narcotics
effects tend to become most apparent in the second half of the first year and become strongly apparent in the second year
|Preschool Period [2 1/2 to 6 years]
||Limited research with inconsistent results
Behavioral effects may be more apparent than cognitive deficits during this period since many skills important in the measurement of intelligence are not fully developed
|School Age [6-13 years]
||Limited research with variable results; more is understood about the cognitive affects of FAS.
The prenatal environment, not the postnatal environment, is the primary determinant of a child's health and development.
The outcomes for children of drug-using parents depend on the dynamic interaction of the child and the social environment. Postnatal factors bear on the ability of the newborn prenatally exposed to drugs to recover; recovery of functioning is facilitated by a favorable care taking environment.
Factors related to mother's prenatal and postnatal status:
Environmental factors in the home associated with developmental outcomes:
- Medical problems: mothers who misuse drugs are less likely to have prenatal care and suffer from a number of medical problems
- Co-morbidity: presence of associated mental health and social problems [histories of childhood physical and sexual abuse, physical abuse during adulthood; depression and associated problems]
Environmental factors related to foster care entry:
- Environmental factors, such as family violence, can be as significant in determining the child's health and developmental outcome as the prenatal substance exposure.
- Environmental factors, such as a nurturing and appropriately stimulating environment, can promote the child's health and development.
- A substantial number of children who have been prenatally exposed to alcohol/drugs - most of whom remain with their birth families - grow up in environments characterized by postnatal risk factors:
- exposure to violence
- inadequate caregiving; inadequate or inappropriate interactions with children
- lack of adult supervision
- parental abuse of alcohol and other drugs
- child abuse and neglect
- foster care entry with multiple placements
- disorganization and instability
With abuse and neglect, there is the risk of foster care entry and for many children, multiple placements while in care - the research confirms that the number of moves a child experiences while in care is more significant in determining how well a child will function later than whether or not the birth mother used drugs during pregnancy
Ornoy, Michailevskaya, and Lukashov (1996): The Developmental Outcome of Children Born to Heroin Dependent Mothers, Raised at Home or Adopted
Israeli study of 5-6 years old, comparing 83 children born to heroin-dependent mothers with 76 children born to heroin-dependent fathers and three control groups: 50 children with environmental deprivation, 50 normal children from families of moderate to high socioeconomic status without environmental deprivation, and 80 children from kindergarten in Jerusalem.
Among the findings:
The researchers concluded that "the developmental outcome of children born to heroin-dependent mothers seemed to be influenced by the environment, as those raised in adopting families had normal development".
- When children born to heroin-dependent mothers were divided to those what were adopted at a very young age and to those raised at home, the adopted children were found to function similarly to the controls while those not adopted functioned significantly lower.
- The children not exposed in-utero to heroin but reared in "neglecting" and "abusing" environments functioned even less well than the children born to heroin dependent mothers.
PRENATAL SUBSTANCE EXPOSURE
conference program | conference materials | findings and recommendations | misconceptions | tips for families |
select bibliography | press release | links